Provider Demographics
NPI:1053037879
Name:FIVE STAR THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:FIVE STAR THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMOL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:848-231-8429
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-0495
Mailing Address - Country:US
Mailing Address - Phone:848-231-8429
Mailing Address - Fax:
Practice Address - Street 1:58 DIANE DR
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-7953
Practice Address - Country:US
Practice Address - Phone:848-231-8429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty